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Examining Anti-Racist Attitudes In Maternity Care Workers, Angelina Aduke Toluhi
Examining Anti-Racist Attitudes In Maternity Care Workers, Angelina Aduke Toluhi
All ETDs from UAB
Racism in maternity care has been identified as one of the major contributors to the persistent racial disparities in maternal health outcomes in the United States (US). Antiracism is a term used to describe the practice of actively identifying and opposing racism with the goal of changing policies, attitudes, behaviors, and beliefs that continue to foster racist ideas and actions. The results of this convergent mixed method research study reveal that racism and other forms of racial discrimination during maternity care may lead to adverse pregnancy outcomes in Non-Hispanic Black (NHB) pregnant patients in Southern US. In the first aim, …
Utilization Of Romosozumab During Covid-19 Pandemic Among U.S. Medicare Beneficiaries, Ye Liu
Utilization Of Romosozumab During Covid-19 Pandemic Among U.S. Medicare Beneficiaries, Ye Liu
All ETDs from UAB
Osteoporosis is increasingly recognized as a major public health issue in the aging U.S. population. Shortly after the licensure of romosozumab, an injectable medication indi-cated for women with postmenopausal osteoporosis at high risk of fracture administered by health care provider monthly, the COVID-19 pandemic broke out, which caused ma-jor disruptions to the delivery of health care across the nation. The pandemic dispropor-tionately affected minority and economically disadvantaged communities, exacerbating many pre-existing health disparities. Romosozumab has the highest dosing frequency among common injectable osteoporosis medications in the U.S. that require an office visit for injection, making romosozumab adherence more susceptible to …
Screening For And Addressing Social Determinants Of Health In Hospitals Participating In Accountable Care Organizations, Heather Lee
All ETDs from UAB
There is a growing recognition among hospitals, payers, and policymakers in the United States that addressing social needs of patients is important to improving quality of care, patient outcomes, and lowering health care spending. Accountable care organizations (ACOs) may be especially incentivized to address social needs of patients to meet population health goals related to patient outcomes and costs. This cross-sectional study used data from the American Hospital Association Annual Survey to explore to explore how hospitals participating in or leading ACOs are screening for and addressing individual-level HRSNs of patients and to understand the extent to which ACOs are …
Access To And Service Utilization Of Alabama Medicaid's Section 1115 Demonstration Waiver Program, Sarah Lee Bowler
Access To And Service Utilization Of Alabama Medicaid's Section 1115 Demonstration Waiver Program, Sarah Lee Bowler
All ETDs from UAB
Background: Much research has been done investigating health disparities in the field of publicly-funding family planning. However, no longitudinal analysis has been conducted to examine the impact of Alabama Medicaid’s Section 1115 demonstration waiver on access to care, experience of barriers reported by enrollees, and repeat utilization of services. Methods: Medicaid enrollment and visit claims data were used to answer the questions related to access and service utilization. Annual Plan First survey data were used to investigate the experience of barriers to care among enrollees. For all three research questions, descriptive statistics were calculated, and linear probability models were used …
Using Hope To Cope: Chronic Stress, Religious Coping, And Masked Hypertension In African American Adults: The Jackson Heart Study, Miriam Miles
All ETDs from UAB
USING HOPE TO COPE: CHRONIC STRESS, RELIGIOUS COPING, AND MASKED HYPERTENSION IN AFRICAN AMERICAN ADULTS: THE JACKSON HEART STUDY ABSTRACT Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP) measured in the doctor’s office. Few data are available on the association of chronic stress with BP measured outside of the office setting. Religious coping, applying religious beliefs to adapt to stressful situations, and functional and structural social support may protect against MHT by promoting active coping behaviors and increasing emotional well-being. High levels of religious involvement and high social support have been …
Maternal, Infant, And Early Childhood Home Visiting And School Readiness In Alabama, Heather H. Johnson
Maternal, Infant, And Early Childhood Home Visiting And School Readiness In Alabama, Heather H. Johnson
All ETDs from UAB
This study examined the relationship between home visiting and school readiness in Alabama. Topics included a scoping review of the home visiting literature, statistical analyses of Alabama’s Teaching Strategies GOLD® (GOLD) data to determine if there were differences in performance among children who received home visiting compared to those who did not, and the development of a Key Driver Diagram (KDD) to inform improvement in home visiting practices that support school readiness. The scoping review of the literature indicated an absence of consistent definitions and measurement of the concept of school readiness. Through thematic analysis of the articles, contextual factors …
Navigating Missed Visits In Hiv Primary Care: Exploring Risk Factors Associated With Missed Visits, Jiaying Hao
Navigating Missed Visits In Hiv Primary Care: Exploring Risk Factors Associated With Missed Visits, Jiaying Hao
All ETDs from UAB
The HIV care continuum is a public health model that outlines the steps or stages people with HIV go through from diagnosis to achieving and maintaining viral suppression. Retention in care, a key component of the HIV care continuum, is critical in achieving good health outcomes for people with HIV (PWH) and preventing HIV transmission. Consistent HIV care is essential for the health of PWH as a part of retention in care. De-spite no standard measure for retention in care to PWH, the missed (no-show) vis-its/appointments is one of the most commonly used methods for evaluating retention in HIV care. …
Unintended Pregnancy, Postpartum Contraception, And Healthcare Utilization Among Young Married Women Affected By Hiv In Kenya, Liza M. Kimbo
Unintended Pregnancy, Postpartum Contraception, And Healthcare Utilization Among Young Married Women Affected By Hiv In Kenya, Liza M. Kimbo
All ETDs from UAB
Women with an unintended pregnancy are at risk of a repeat unintended pregnancy. Although use of postpartum contraception is an effective way to prevent repeat unintended pregnancies, the majority of unintended pregnancies globally occur in women who are not using contraception. Unintended pregnancies can have negative health and social consequences for both women and their children. This study aimed to better understand the use of postpartum contraceptives and healthcare services by married women with unintended versus intended pregnancy in south-western Kenya, with a special focus on young women. The study followed an exploratory sequential mixed methods design. In the first …
Access To The Kidney Transplant Waitlist For People Living With Hiv, Brittany A. Shelton
Access To The Kidney Transplant Waitlist For People Living With Hiv, Brittany A. Shelton
All ETDs from UAB
People living with HIV (PLWH) have experienced substantial increases in life expectancy, largely attributable to improvements in care such as antiretroviral therapy. As a result, there has been a concurrent increase in the development of aging-related comorbidities such as end-stage organ disease. One such comorbidity is kidney disease. Concerningly, PLWH are at disproportionately higher risk of chronic kidney disease and end-stage kidney disease (ESKD) as compared to HIV-negative counterparts. Kidney transplantation is the ideal therapy for ESKD as it is both cost-effective and provides a significant survival benefit and yet, despite excellent transplant outcomes among PLWH, access to transplantation among …
Guided Exploration Of Military Servicewomen's Healthcare Experiences And Related Outcomes (Gems Hero), Princess Victoria Jane Nash
Guided Exploration Of Military Servicewomen's Healthcare Experiences And Related Outcomes (Gems Hero), Princess Victoria Jane Nash
All ETDs from UAB
Purpose: This study focuses on factors related to healthcare seeking behaviors and utilization of Veterans Affairs primary care services by female African American Veterans. The purpose of this mixed methods study is to assess what factors influence seeking care at VA healthcare facilities. Research Design: This study used a modified explanatory sequential mixed methods design to assess health services utilization and healthcare experiences of African American female Veterans. This research utilized items from the Health Belief model as a guiding framework to highlight factors that could impact VA healthcare utilization. Methodology: Health services utilization analysis used national data from the …
Statistical Methods For Evaluating Confounding In Nutritional Epidemiology: Examining The Association Of Dietary Measures And Incident Type 2 Diabetes, Stephanie E. Tison
Statistical Methods For Evaluating Confounding In Nutritional Epidemiology: Examining The Association Of Dietary Measures And Incident Type 2 Diabetes, Stephanie E. Tison
All ETDs from UAB
Nutrition is a key factor in the development of noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, obesity, and cancer, which are continuing to increase globally. Research on dietary patterns is crucial for informing what aspects of diet are most critical for preventing and possibly reversing chronic disease. Dietary patterns focus on the types of food that are consumed which reflects the complexity and cultural aspects of diet rather than focusing on a single food or nutrient. Observational cohort studies are able to observe typical dietary intake and thus better reflect the real association between diet and chronic disease. In …
Mental Health And Chronic Disease Management: Examining The Association Between Depression And Multiple Sclerosis (Ms) Outcomes, Christina J. Glenn
Mental Health And Chronic Disease Management: Examining The Association Between Depression And Multiple Sclerosis (Ms) Outcomes, Christina J. Glenn
All ETDs from UAB
The aim of this dissertation is to determine whether depression is associated with clinical (relapses and disability worsening) and MRI outcomes in multiple sclerosis (MS) by conducting a secondary data analysis of the CombiRx clinical trial. Psychiatric comorbidities, including depression are common in people living with MS (PwMS), often underreported, and contribute to reduced quality of life and mortality associated with the disease. Most clinical studies that have examined the relationship between depression, depression medication usage, and MS outcomes have been small, excluded participants with relapsing-remitting subtypes and severe depressive symptoms, and had relatively short study periods—all shortcomings this thesis …
Challenges And Promising Strategies For Maximizing Pregnant Women's Adherence And Retention In Niv Care In The Context Of Option B+ In Kenya, Anna Helova
All ETDs from UAB
Under the current Kenyan guidelines, pregnant/postpartum women who test HIV-positive are immediately put on the lifelong antiretroviral (ART) therapy (Option B+) and are initiated into the prevention of mother-to-child (PMTCT) protocol. Gaps at each step of the PMTCT continuum undermine the positive impact of lifelong ART. Challenges at the individual, interpersonal, community, and health facility-levels contribute to these gaps. A community-based mentor mother (cMM) program tested under the Mother-Infant Visit Adherence and Treatment Engagement(MOTIVATE!) Trial (NICHD R01 R01HD080477; ClinicalTrials.gov#14-0331) is a potential approach to address these challenges. The three manuscripts comprising this dissertation used qualitative and quantitative methods with the …
Employer Sponsored Health Insurance And Children With Special Health Care Needs, Kathryn Corvey
Employer Sponsored Health Insurance And Children With Special Health Care Needs, Kathryn Corvey
All ETDs from UAB
This dissertation is composed of three papers related to children with special health care needs (CSHCN) who are covered by private health insurance, including employer sponsored health insurance. Over the past couple of decades, researchers and advocates have expressed concern about the impact that widespread changes in private insurance coverage may have on families of CSHCN. These researchers point to the rise in high deductible plans and declining generosity in the form of higher premiums and copayments in more traditional plans offered by employers. Despite this expressed concern, little research has been conducted examining how these changes in employer sponsored …
Hospital Charge And Ricing Transparency, Kunal N. Patel
Hospital Charge And Ricing Transparency, Kunal N. Patel
All ETDs from UAB
Hospital pricing is not uniformly disclosed to patients up-front before the delivery of healthcare. Moreover, pricing is not commonly understood by consumers and researchers, because the information was largely unavailable due to the lack of a federal policy mandate to make the information publicly available up until recently. The federal government instituted a series of regulations that initially began to take effect in 2019 in order to increase hospital pricing transparency with the aim of bending the healthcare cost curve. In this dissertation, hospital response, hospital standard charge variation, and healthcare management and policy expert opinion surrounding the implementation of …
Understanding Financial Hardship In Women With Breast Cancer, Courtney Williams
Understanding Financial Hardship In Women With Breast Cancer, Courtney Williams
All ETDs from UAB
Individuals with cancer are at risk of material, psychological, and behavioral financial hardship due to costly new treatments, increasing time on treatment, and longer survival. Breast cancer is an ideal environment to study financial hardship. Treatment options for metastatic breast cancer are heterogeneous due to differences in patient characteristics, disease biology, and because it has the largest number of treatment options of any metastatic cancer. In early stage breast cancer, treatment options include multimodality treatments, including surgery, radiation, and medical therapy (chemotherapy, hormone therapy, targeted therapy), with the choice for each modality being dependent on the other modality decisions. Despite …
Translating Public Health Strategies To Examine Hypertensive Disorders Of Pregnancy In Alabama, Matthew Dean Moore
Translating Public Health Strategies To Examine Hypertensive Disorders Of Pregnancy In Alabama, Matthew Dean Moore
All ETDs from UAB
Hypertensive disorders of pregnancy (HDP) are on the rise in the United States and contribute significantly to maternal and infant morbidity and mortality. The impact of such disorders is especially burdensome for women insured by Medicaid, for those who live in the South, and for those representing racial and ethnic minorities. It is evident across the aims of this dissertation that HDP remains an important public health concern to stakeholders in Alabama, its diagnosis is influenced by various maternal characteristics, and it can result in disparate severe outcomes for some populations. The first aim examines systems level decision-making in the …
Increasing Living Kidney Donation Through Advocacy And Patient Navigation, Rhiannon Deierhoi Reed
Increasing Living Kidney Donation Through Advocacy And Patient Navigation, Rhiannon Deierhoi Reed
All ETDs from UAB
As the prevalence of kidney disease continues to increase in the United States, the gap between the need for organs and available kidney donors is growing as well. Deceased donor organs alone are insufficient to meet this need, and transplant centers have turned their focus to living donation to address the shortage. However, the frequency of living kidney donation has been declining in the US since 2004. Changes in the health of the US population have been suggested as one possible explanation for the decline, but currently these assertions remain anecdotal. A second theory with more published evidence attributes the …
Examining The Impact Of Couple Relationship Factors On Male Engagement Pregnancy Health And Communal Coping, Pamela Musoke
Examining The Impact Of Couple Relationship Factors On Male Engagement Pregnancy Health And Communal Coping, Pamela Musoke
All ETDs from UAB
Focusing on male partner engagement in HIV prevention is an important aspect of intervention and policy development and implementation within the sub-Saharan African context. However, engaging male partners safely and effectively to improve the impact and sustainability of HIV prevention modalities remains challenging due to continued impact of traditional gender roles that may affect the willingness and confidence to engage in pregnancy health. Additionally, the lack of knowledge of how best to engage in pregnancy health beyond financial support makes it difficult for male partners to engage. This dissertation’s overall aim is to explore aspects of male partner engagement's influences …
Impact Of Environmental Exposures On Respiratory Health, Lawrence Rasmussen
Impact Of Environmental Exposures On Respiratory Health, Lawrence Rasmussen
All ETDs from UAB
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality around the world. Cigarette smoking is a leading cause of COPD; similarly, individuals exposed to secondhand smoke (SHS) are also vulnerable to COPD and other airway diseases; however, distinct molecular mechanisms involved in SHS-induced lung effects that result in COPD are poorly understood. Mucociliary clearance (MCC) is a primary lung defense against inhaled particulate matter and pathogens. Thus, understanding how inhaled irritants such as SHS disrupt MCC will promote improved scientific understanding and better public health initiatives to prevent respiratory illnesses. Using a variety of in vitro …
Social Factors, Public Policies, And Infant Mortality, Lauren Wallace
Social Factors, Public Policies, And Infant Mortality, Lauren Wallace
All ETDs from UAB
Despite consistent and substantial investments, the United States’ infant mortality rate (IMR) has not decreased significantly in the 21st century and disparities between racial and ethnic groups have increased. This study investigates the impact of social and health factors, and public policies on IMR at the state level. The research aims were to: 1) evaluate which state-level social factors and public policies were associated with state IMRs using principal component (PC) analysis; and 2) evaluate whether states cluster on their PC scores and IMRs using cluster analysis. The data used were six composite index scores based on social factor and …
Cigarette Smoking Among Hiv-Positive Patients In Routine Clinical Care, Cosmas Mudenda Zyambo
Cigarette Smoking Among Hiv-Positive Patients In Routine Clinical Care, Cosmas Mudenda Zyambo
All ETDs from UAB
People living with HIV (PLWH) are two to three times more likely to be current smokers, less likely to quit smoking and more likely to relapse than those in the general population. Although smoking status, prescription of smoking cessation medications (SCMs), smoking cessation and relapse has been explored in this population, few have investigated using a large sample of PLWH receiving routine HIV care. Using data from a large observational cohort of PLWH receiving routine care in Birmingham, we determined: 1) Factors associated with smoking status; 2) Factors associated with prescription of SCMs; 3) Predictors of smoking cessation and; 4) …
Effects Of Medicare Reimbursement Policies On The Quality Of Hospital Care, Monica Aswani
Effects Of Medicare Reimbursement Policies On The Quality Of Hospital Care, Monica Aswani
All ETDs from UAB
This dissertation is composed of two papers related to the role of social risk factors in the Hospital Readmissions Reduction Program (HRRP). As value-based initiatives like the HRRP become more commonplace, there is growing need to understand the relationship between performance in these programs and social risk factors, such as race and poverty, which are not incorporated in the program’s risk adjustment methodology. To address this gap in the literature, this dissertation specifically focuses on three areas: 1) how hospital and community factors are related to average HRRP penalties, taking the context of geography into account, 2) how hospital and …
Implementation Of Repeat Hiv Testing During Pregnancy In Kenya, Anna Joy Graves Rogers
Implementation Of Repeat Hiv Testing During Pregnancy In Kenya, Anna Joy Graves Rogers
All ETDs from UAB
It is estimated that a third of all mother-to-child transmission (MTCT) of HIV occurs in women with incident HIV infection during pregnancy, potentially contributing to over 37,000 pediatric HIV infections globally and 4,300 infections in Kenya on an annual basis. Since most pregnant women with acute HIV infection test negative for HIV during routine early-pregnancy antenatal testing, they may not receive access to life-saving antiretroviral therapy (ART) for their own sake, as well as to prevent perinatal HIV transmission. A comprehensive strategy to eliminate MTCT will require identifying and addressing incident HIV infection. International recommendations suggest that pregnant women in …
Autism Spectrum Disorders And Social-Ecological Models: Understanding How Context Drives Prevalence, Anne Elizabeth Brisendine
Autism Spectrum Disorders And Social-Ecological Models: Understanding How Context Drives Prevalence, Anne Elizabeth Brisendine
All ETDs from UAB
Background: While there has been significant work done to explore disparities in autism spectrum disorder (ASD) diagnoses with respect to individual characteristics, little work has been done to examine the overall system and structure of the environment in which ASD identification is made and how it is related to diagnosis and services. The purpose of this study is to better understand the social-ecological factors that impact ASD diagnoses at the population level. Methods: In the first aim of this dissertation, a tailored social ecological model was developed and examined across variables in the 2011/12 National Survey of Children’s Health. In …
Individual And Institutional Level Factors That Influence Hiv Testing And Counseling Utilization During Antenatal Care In Nigeria, Modupeoluwa O. Durojaiye
Individual And Institutional Level Factors That Influence Hiv Testing And Counseling Utilization During Antenatal Care In Nigeria, Modupeoluwa O. Durojaiye
All ETDs from UAB
Of the estimated 150,000 new HIV infections in children in 2015, 122,000 occurred in sub-Saharan Africa (SSA), with Nigeria accounting for a third of all cases. Most of these infections were acquired via mother-to-child transmission (MTCT). HIV testing and counseling, a critical first step in the prevention of MTCT (PMTCT), can ensure that HIV-positive women access services that can reduce HIV transmission risk. Incorporating HIV testing and counseling into antenatal care (ANC) is an integral component of the World Health Organization (WHO) strategies. This dissertation aims to understand factors that influence HIV testing and counseling during ANC. It is comprised …
Publc Hospital Conversions: A Question Of Social Capital?, Antionette Smith Epps
Publc Hospital Conversions: A Question Of Social Capital?, Antionette Smith Epps
All ETDs from UAB
ABSTRACT Between 1975 and 2015, the number of public hospitals decreased by 43%, from 1761 to 1003. Public hospitals have undergone changes in ownership status, structural and/or governance conversions and closures. Reasons for these changes are varied and numerous, however, many studies identify financial difficulties as a major reason that decision-makers consider an ownership change. Some public hospitals persist despite exhibiting financial issues. Therefore, there may be other factors contributing to the persistence of some public hospitals. This paper examines the potential role of social capital or community engagement and cohesion as a factor in determining if a public hospital …
Quality Of Care And Racial Disparities In Head And Neck Cancer Treatment, Siddharth Jain
Quality Of Care And Racial Disparities In Head And Neck Cancer Treatment, Siddharth Jain
All ETDs from UAB
PURPOSE: Intensity-modulated radiotherapy (IMRT) is a development of conventional radiotherapy in the treatment for most Head and Neck Cancers (HNC). There is no sufficient evidence to suggest that some physicians are associated with better outcomes in HNC patients. Also, there is limited data that showed that African Americans have poor outcomes compared to other races among HNC patients. We conducted a cross-sectional analysis to evaluate the effect of radiation oncologist characteristics on outcomes in HNC patients treated with IMRT, and factors associated with racial disparities in the treatment outcomes. METHODS: The study used Surveillance Epidemiology and End Results (SEER)-Medicare linked …
Modeling Depression Treatment Strategies For Human Immunodeficiency Virus (Hiv) Positive Patients, Rongbing Xie
Modeling Depression Treatment Strategies For Human Immunodeficiency Virus (Hiv) Positive Patients, Rongbing Xie
All ETDs from UAB
This dissertation empirically examines the associations between depression and HIV-related outcomes, simulates both care and outcomes under different depression care strategies, and compares the cost effectiveness of various depression care strategies to the current care strategy. The empirical investigations reveal the negative associations between depression and HIV-related outcomes using two longitudinal patient-level databases. Furthermore, the patterns and outcomes of depression care are identified and simulated using agent-based modeling. Finally, simulated costs and effectiveness are used to evaluate different depression care strategies for reducing new HIV infections and improving quality of life. The current standard of care for depression among patients …
Measuring Reproductive Norms And Stigma And Examining Their Roles In Unintended Pregnancy-Related Health Behavior Among Young Adult Women, Whitney Smith
All ETDs from UAB
Substantial disparities are observed in rates of unintended pregnancy and the health consequences of unintended pregnancy in the United States, with these events and outcomes occurring more frequently among young adult women and women in the southern region. The contribution of social norms and stigma to these disparities is unclear. This dissertation is comprised of three manuscripts examining unintended pregnancy-related norms and stigma, and their health implications among young adult women aged 18-24 in Birmingham, Alabama. The aims of the dissertation are to (1) elucidate perceptions of norms and stigma regarding unintended pregnancy and pregnancy decisions (abortion, adoption, and parenting), …